Minimally Invasive Techniques for Urolithiasis Management

Minimally invasive interventions have transformed the management of urinary tract stones by reducing patient morbidity, shortening hospital stays and improving stone clearance rates. Shock wave lithotripsy (SWL) remains a non‐invasive first line for small to moderate stones, while ureteroscopic approaches employ flexible or rigid scopes to access ureteric and intrarenal calculi. Laser lithotripsy with holmium:YAG or novel thulium fibre lasers allows precise fragmentation or “dusting” of stones, facilitating spontaneous passage or retrieval with baskets. Percutaneous nephrolithotomy (PCNL) has evolved through tract downsizing to “mini” and “ultra‐mini” formats, lowering bleeding and postoperative discomfort. Adjunct technologies such as ureteral access sheaths, improved imaging guidance and novel retrieval devices—including magnetically responsive coatings—enhance fragment clearance. Collectively, these innovations have broadened the spectrum of treatable stones, standardised perioperative pathways and improved global access to safe, efficient stone care.

Research from Nature Portfolio

Recent studies have introduced a magnetic hydrogel coating that renders residual stone fragments magnetisable, enabling their efficient capture with a simple magnetic instrument during ureteroscopy. In vitro and in vivo assessments demonstrate robust fragment retrieval across common stone compositions, with negligible cytotoxicity and only superficial effects on urothelium. The hydrogel also exhibits antimicrobial properties comparable to standard antibiotics, offering dual benefits of improved stone clearance and reduced infection risk. This platform technology promises to elevate stone-free rates and streamline endoscopic procedures by minimising reliance on basket extraction.

Minimally Invasive Techniques for Urolithiasis Management publication trend

The graph below shows the total number of articles in minimally invasive techniques for urolithiasis management across all publications each year (not limited to Nature Index journals).

Technical terms

Percutaneous nephrolithotomy (PCNL): A technique involving a small skin incision and renal tract creation to access and fragment kidney stones.

Miniaturised PCNL (mPCNL): A variant of PCNL using sheaths smaller than 18 Fr to reduce bleeding and postoperative pain.

Ureteroscopy (URS): Endoscopic access to ureteric or intrarenal stones via the urethra and bladder, often employing laser lithotripsy.

Holmium:YAG laser lithotripsy: A pulsed mid-infrared laser system that fragments stones by photothermal effects within water.

Thulium fibre laser lithotripsy: A fibre-delivered continuous or quasi-continuous laser offering high pulse rates and fine dusting capability.

Stone-free rate (SFR): The proportion of patients with no detectable stone fragments following intervention.

Magnetic hydrogel: A biocompatible polymer coating that binds to stone fragments and confers magnetism for retrieval.

References

1. International Alliance of Urolithiasis (IAU) consensus on miniaturized percutaneous nephrolithotomy. Military Medical Research (2024).
2. A magnetic hydrogel for the efficient retrieval of kidney stone fragments during ureteroscopy. Nature Communications (2023).
3. Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. European Urology (2022).
4. Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis. PLOS ONE (2019).